Antiaquaporin-4 antibodies and infectious myelitis

Background: Testing for aquaporin-4 IgG antibodies (NMO-IgG) is highly recommended in the presence of centromedullary multi-segmental lesions at magnetic resonance imaging (MRI), a pattern considered to be highly suggestive of neuromyelitis optica (NMO). However, infectious and post-infectious disor...

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Bibliographic Details
Published in:Multiple sclerosis 2008-09, Vol.14, p.S115-S115
Main Authors: Brum, D G, Donadi, E A, Santos, A C, Takayanagui, OM, Marques, W, Barreira, A A
Format: Article
Language:English
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Summary:Background: Testing for aquaporin-4 IgG antibodies (NMO-IgG) is highly recommended in the presence of centromedullary multi-segmental lesions at magnetic resonance imaging (MRI), a pattern considered to be highly suggestive of neuromyelitis optica (NMO). However, infectious and post-infectious disorders may display a similar pattern and it may be difficult to distinguish between them. Objective: To report the association between infectious myelitis, centromedullary multisegmental lesions and NMO-IgG. Methods: The cases of two patients exhibiting centromedullary multisegmental lesions at MRI who presented with infectious myelitis and NMO-IgG are presented. Results: Case 1: A 59-year-old man with lower limbs paraparesis, sensory level at D10, and urinary and fecal incontinence. MRI showed multisegmental high-signal intensities in the cervical and thoracic spinal cord segments and a cystic lesion on T2-weighted images. Cerebrospinal fluid and serological tests were positive for Paracocddioides brasiliensis. Serum NMO-IgG examined at the Mayo Clinic was positive. Sulphadiazine and dexametasone therapy was started. After 30 days there was no significant improvement. He was discharged wheel-chair bound, with urinary and fecal incontinence. Case 2: A 58-year-old woman was admitted with spastic paraparesis, left ptosis and sensory level at D2. MRI revealed high-intensity gadolinium-enhanced signal in the central portion over the entire length of the spinal cord on T2-weighted images. Laboratory examination revealed elevated anti-HTLV-I antibody title and viral load. She was treated with 1000 mg methyl-prednisolone for three days, followed by monthly therapy for six months. She improved gradually and stabilization occurred after six months (expanded disability status scale was 6.5). Serum NMO-IgG examined at the Mayo clinic was positive. The myelopathy had worsened at the last follow-up visit, despite the viral load reduction. Conclusions: Although NMO-IgG has been primarily examined in autoimmune neurological disorders, it has not been routinely evaluated in infectious or post-infectious myelopathies. Our findings indicate the need for further studies on the association between NMO-IgG and infectious myelitis.
ISSN:1352-4585